To investigate survival, efficacy, and safety of selective internal
yttrium-90 radioembolization
therapy (Y-
SIRT) in patients with unresectable metastatic
melanoma (MM) to liver refractory to systemic
therapy.
METHODS: An IRB-approved retrospective review of 58 patients diagnosed with unresectable MM to the liver, refractory to systemic
therapy, between February 2003 and March 2012 was conducted. Of these, 28 received resin-based Y-
SIRT (group A), and 30 patients received best supportive care (group B). Survival was calculated using the Kaplan-Meier method and Cox proportional hazard models.
RESULTS: Groups A and B were similar for the Child-Pugh class, ECOG scores, age, sex, and race. Median overall survival (OS) from diagnosis of primary
melanoma in groups A and B were 119.9 and 26.1 months, respectively (P<0.001). Median OS from hepatic
metastasis in groups A and B were 19.9 and 4.8 months, respectively (P<0.0001). In group A, median OS from hepatic
metastasis in the Child-Pugh A, B, and C patients was 37.7, 4.2, and 3.6 months, respectively (P<0.001). In group B, median OS from hepatic
metastasis in the Child-Pugh A, B, and C patients was 7.8, 4.2, and 1.9 months, respectively (P=0.04). Within group A, median OS from first Y-
SIRT was 10.1 months; median OS of the Child-Pugh A, B, and C patients from first Y-
SIRT was 10.3, 1.2, and 0.9 months, respectively (P=0.04). Median OS from first Y-
SIRT was significantly greater in the absence of diffuse (>10) liver
metastases (15.1 vs. 4.7 mo, P=0.02), and in the absence of extrahepatic
metastases (21.3 vs. 8.6 mo, P<0.001). Common clinical toxicities following Y-
SIRT included
abdominal pain (17.9%),
fatigue (14.3%), and self-limiting grade III
bilirubin toxicity (10.7%).
CONCLUSION: For patients with unresectable MM to the liver refractory to systemic
therapy, resin-based Y was associated with longer survival from liver
metastases than best supportive care. Child-Pugh A patients with <10 metastatic lesions and absence of extrahepatic
metastases demonstrated greatest survival following Y-
SIRT.